Compositions and methods containing substituted quinolines and substituted 
diphenylsulfones

ABSTRACT

Combination therapies of substituted quinolines and substituted diphenyl sulfones are disclosed. More specifically, compositions containing substituted quinolines and substituted diphenyl sulfones are disclosed. In addition, methods of using the compositions in the treatment of neurodegenerative disorders, including, inter alia, Alzheimer&#39;s dementia, HIV-1 associated dementia, and Creutzfeld-Jakob disease are also disclosed.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of Application Ser. No. 60/443,219,filed Jan. 27, 2003, the disclosure of which is incorporated byreference in its entirety.

REFERENCE TO GOVERNMENT GRANTS

Portions of the disclosure herein may have been supported in part bygrants from the National Institutes of Health, Grant No. NS25637,AG12548, and NS34000. The United States Government may have certainrights in this application.

FIELD OF THE INVENTION

The present invention generally relates to combination therapies ofsubstituted quinolines and substituted diphenyl sulfones. Morespecifically, the present invention relates to compositions containingsubstituted quinolines and substituted diphenyl sulfones and methods ofusing the compositions in the treatment of neurodegenerative disorders,including, inter alia, Alzheimer's dementia, HIV-1 associated dementia,or Creutzfeld-Jakob disease.

BACKGROUND OF THE INVENTION

Alzheimer's disease is a slowly progressive, neurodegenerative disorderthat involves abnormalities in β-amyloid (Aβ) metabolism, the formationof β-amyloid plaques, chronic neuroinflammation, and loss of synapsesand neurons in the neocortex and hippocampus. It is generally believedthat the loss of synapses and neurons account for the severe defects incognition associated with Alzheimer's disease.

Neuroinflammation and neuron loss is believed to be involved in severalneurodegenerative disorders, including Alzheimer's dementia, HIV-1associated dementia, spongiform encephalopathy, Creutzfeld-Jakobdisease, stroke, trauma, multiple sclerosis, Parkinson's disease, HIVinfection of the central nervous system, hereditary hemorrhage withamyloidosis-Dutch type, cerebral amyloid angiopathy, or Down's syndrome,and the like.

Although much effort has been expended to develop therapeutics forAlzheimer's disease and other neurodegenerative diseases associated withneuroinflammation and neuron loss, little progress has been made inidentifying agents that provide neuroprotection.

Therefore, it would be desirable to identify neuroprotective agentsuseful for the prevention and treatment of neurodegenerative disorders,especially those associated with neuroinflammation, neuron loss, andcognitive loss. The compositions and methods of the present inventionare directed toward these, as well as other, important ends.

SUMMARY OF THE INVENTION

Accordingly, the present invention is directed, in part, to compositionsand methods useful for the prevention and treatment of neurodegenerativedisorders, especially those associated with neuroinflammation, neuronloss, and cognitive loss.

In one aspect, the invention is directed to pharmaceutical compositions,comprising:

-   -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I:    -   or pharmaceutically-acceptable salt or prodrug thereof;    -   wherein:    -   A, B, C, and D are, independently, H, lower alkyl, cyano, OR⁵,        —C(═O)OR⁵, SR⁶, halo, SO₂R⁶, NR⁶R⁷, —SO₂NR⁶R⁷;    -   R¹ and R² are, independently, NH₂, NHC(═O)R³, or —N═NR⁴;    -   R³ is H, lower alkyl, -alkyl-OR⁵, -alkyl-C(═O)OR⁵, or        -alkyl-C(═O)NHR⁵:    -   R⁴ is    -   R⁵ is hydrogen, lower alkyl, substituted lower alkyl, lower        alkenyl, substituted lower alkenyl, lower alkynyl, substituted        lower alkynyl, aryl, haloaryl, substituted aryl, acyl, or        heterocyclyl;    -   R⁶ is independently hydrogen, alkyl, substituted lower alkyl,        lower alkenyl, substituted lower alkenyl, lower alkynyl,        substituted lower alkynyl, alkyl substituted aryl, or acyl; and    -   R⁷ is independently hydrogen, alkyl, substituted lower alkyl,        lower alkenyl, lower alkynyl, substituted lower alkenyl,        substituted lower alkynyl, alkyl substituted aryl, acyl, —SO₂R⁵,        or SO₂NR⁵R⁶.

In another aspect, the invention is directed to method of treating adisorder associated with neuron loss, comprising the step of:

-   -   administering to a patient in need thereof an effective amount        of the composition, comprising:    -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I or        pharmaceutically-acceptable salt or prodrug thereof, as defined        above.        The disorders associated with neuron loss include, inter alia,        Alzheimer's dementia, HIV-1 associated dementia, spongiform        encephalopathy, Creutzfeld-Jakob disease, stroke, trauma,        multiple sclerosis, Parkinson's disease, HIV infection of the        central nervous system, hereditary hemorrhage with        amyloidosis-Dutch type, cerebral amyloid angiopathy, or Down's        syndrome.

In yet another aspect, the invention is directed to methods of treatinga neurodegenerative disorder, comprising the step of:

-   -   administering to a patient in need thereof an effective amount        of the composition, comprising:    -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I or        pharmaceutically-acceptable salt or prodrug thereof, as defined        above.        The neurodegenerative disorders include, inter alia, Alzheimer's        dementia, HIV-1 associated dementia, spongiform encephalopathy,        Creutzfeld-Jakob disease, stroke, trauma, multiple sclerosis,        Parkinson's disease, HIV infection of the central nervous        system, hereditary hemorrhage with amyloidosis-Dutch type,        cerebral amyloid angiopathy, or Down's syndrome.

In further aspect, the invention is directed to methods of treating apatient at risk of cognitive loss, comprising the step of:

-   -   administering to said patient an effective amount of the        composition, comprising:    -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I or        pharmaceutically-acceptable salt or prodrug thereof, as defined        above.        Such patients may be afflicted with mild cognitive impairment,        mild cognitive motor dysfunction, HIV-associated dementia,        neuro-AIDS, prion disease, acute stroke or acute trauma.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a plot of % neuron loss for several test agents in a rat modelwith Alzheimer's disease (AD).

FIG. 2 is a plot of % neuron loss as a function of drug concentrationfor several test agents.

FIG. 3 is an isobologram of hydroxychloroquine and dapsone.

FIG. 4 shows improvement in Alzheimer cognition by cumulative T scoresfor cognitive test battery (six month clinical trial).

FIG. 5 shows improvement in HIV cognition with combined drug product ofthe invention (six week clinical trial).

DETAILED DESCRIPTION OF THE INVENTION

The present invention is generally directed to combinations therapiesfor the prevention and/or treatment of neurodegenerative disorders,especially those associated with neuroinflammation and neuron loss. Inone aspect, the invention is directed to compositions comprisingsubstituted quinolines and substituted diphenyl sulfones. In anotheraspect, the invention is directed to the use of such compositions in theprevention and/or treatment of neurodegenerative disorders, including,inter alia, Alzheimer's dementia, HIV-1 associated dementia, andCreutzfeld-Jakob disease.

As employed above and throughout the disclosure, the following terms,unless otherwise indicated, shall be understood to have the followingmeanings.

As used herein and in the appended claims, the singular forms “a,” “an,”and “the” include the plural reference unless the context clearlyindicates otherwise.

As used herein, “halo” refers to —F, —Cl, or —Br.

As used herein, “alkyl” refers to a saturated straight, branched,cyclic, or multicyclic hydrocarbon having from 1 to about 20 carbonatoms (and all combinations and subcombinations of ranges and specificnumbers of carbon atoms therein). The term “lower alkyl” herein refersto those alkyl groups having from about 1 to about 10 carbon atoms,these being preferred. Alkyl groups include, but are not limited to,methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, isobutyl,t-butyl, cyclobutyl, n-pentyl, cyclopentyl, isopentyl, neopentyl,n-hexyl, isohexyl, cyclohexyl, cycloheptyl, cyclooctyl,decahydronaphthalenyl, adamantyl, 3-methylpentyl, 2,2-dimethylbutyl, and2,3-dimethylbutyl. Alkyl groups can be substituted or unsubstituted.

As used herein, “haloalkyl” means an alkyl group substituted with one ormore halo groups selected from —F or —Cl.

As used herein, “alkoxy” means an alkyl-O-moiety, wherein “alkyl” asdefined above.

As used herein, “haloalkoxy” means an alkoxy group substituted with oneor more halo groups selected from —F and —Cl.

As used herein, “alkenyl” refers to an alkyl group having one or moredouble bonds. The term “lower alkenyl” herein refers to those alkenylgroups having from about 2 to about 10 carbon atoms.

As used herein, “alkynyl” refers to an alkyl group having one or moretriple bonds. The term “lower alkynyl” herein refers to those alkynylgroups having from about 2 to about 10 carbon atoms.

As used herein, “aryl” refers to a mono-, di-, tri-, or othermulticyclic aromatic ring system having from about 5 to about 30 carbonatoms (and all combinations and subcombinations of ranges and specificnumbers of carbon atoms therein), with from about 6 to about 14 carbonsbeing preferred. Non-limiting examples include phenyl, naphthyl,anthracenyl, and phenanthrenyl. Aryl groups can be substituted orunsubstituted.

As used herein, “haloaryl” refers to means an aryl group substitutedwith one or more halo groups selected from —F, —Cl, and —Br.

As used herein, “aralkyl” or “arylalkyl” refers to aryl-substitutedalkyl radicals having from about 6 to about 50 carbon atoms (and allcombinations and subcombinations of ranges and specific numbers ofcarbon atoms therein), with from about 6 to about 20 carbon atoms beingpreferred. Non-limiting examples include, for example, benzyl,phenylethyl, 3-phenylprop-1-yl, tetrahydronaphthalenyl,3-phenylprop-2-yl, and 4-naphthylhex-1-yl. Aralkyl groups can besubstituted or unsubstituted. Substitution may occur on the aryl ringcarbons or alkyl carbons of the aralkyl.

As used herein, “heteroaryl” refers to a mono-, di-, tri-, or othermulticyclic aromatic ring system that includes at least one, andpreferably from 1 to about 4 sulfur, oxygen, or nitrogen heteroatom ringmembers. Heteroaryl groups can have, for example, from about 3 to about50 carbon atoms (and all combinations and subcombinations of ranges andspecific numbers of carbon atoms therein), with from about 4 to about 10carbons being preferred. Non-limiting examples of heteroaryl groupsinclude, for example, pyrrolyl, furyl, pyridyl, 1,2,4-thiadiazolyl,pyrimidinyl, isothiazolyl, thiazolyl, triazolyl, imidazolyl, tetrazolyl,pyrazinyl, quinolyl, isoquinolyl, thiophenyl, benzothienyl,isobenzofuryl, pyrazolyl, indolyl, purinyl, carbazolyl, benzimidazolyl,oxazolyl, and isoxazolyl. Heteroaryl groups can be substituted orunsubstituted.

As used herein, “acyl” refers to an alkyl-C(═O)— or an aryl-C(═O)—group.

Typically, substituted chemical moieties include one or moresubstituents that replace hydrogen. Exemplary substituents include, forexample, halo (e.g., —F, —Cl, —Br), (provided that when halo is —Br, the—Br is attached to an sp² carbon such as on a carbon of an alkenyl or aring carbon of aryl or heteroaryl group), alkoxy, haloalkoxy, —OCF₃,alkylthio, monohaloalkylthio, polyhaloalkylthio, —SCF₃, alkyl, —CF₃,haloalkyl, lower alkyl, spiroalkyl, alkenyl, alkynyl, aralkyl, aryl,heteroaryl, heterocyclyl, hydroxyl (—OH), nitro (—NO₂), cyano (—CN),sulfonyl (—SO₂R⁴), sulfamoyl (—SO₂NR⁵R⁶), —SR⁴, amino (—NH₂, NHR⁵, NHR⁶,N(R⁵R⁶) and the like.

As used herein, “side effect” refers to a consequence other than theone(s) for which an agent or measure is used, as the adverse effectsproduced by a drug, especially on a tissue or organ system other thenthe one sought to be benefited by its administration. In the case, forexample, of agents for the prevention or treatment of neuron loss orneurological disorders, the term “side effect” may preferably refer tosuch conditions as, for example, erythocytic and gastrointestinaleffects.

As used herein, “effective amount” refers to an amount of a compound asdescribed herein that may be effective to inhibit, or treat the symptomsof particular disease, disorder, or side effect, or to prevent, inhibit,or diminish the onset of the symptoms of particular disease, disorder,or side effect. Such diseases, disorders, and side effects include, butare not limited to, Alzheimer's dementia, HIV-1 associated dementia,spongiform encephalopathy, Creutzfeld-Jakob disease, stroke, trauma,multiple sclerosis, Parkinson's disease, HIV infection of the centralnervous system, hereditary hemorrhage with amyloidosis-Dutch type,cerebral amyloid angiopathy, or Down's syndrome.

As used herein, “treating” refers to the preventative, curative, andpalliative treatment of a condition, and includes, in particular, notonly the prevention and/or treatment of a condition per se, but also theprevention of the progression of a condition, such as, for example, theprogression of Alzheimer's dementia.

As used herein, “pharmaceutically acceptable” refers to those compounds,materials, compositions, and/or dosage forms that are, within the scopeof sound medical judgment, suitable for contact with the tissues ofhuman beings and animals without excessive toxicity, irritation,allergic response, or other problem complications commensurate with areasonable benefit/risk ratio.

As used herein, “pharmaceutically acceptable salts” refer to derivativesof the disclosed compounds wherein the parent compound is modified bymaking acid or base salts thereof. Examples of pharmaceuticallyacceptable salts include, but are not limited to, mineral or organicacid salts of basic residues such as amines; alkali or organic salts ofacidic residues such as carboxylic acids; and the like. Thus, the term“acid addition salt” refers to the corresponding salt derivative of aparent compound that has been prepared by the addition of an acid. Thepharmaceutically acceptable salts include the conventional salts or thequaternary ammonium salts of the parent compound formed, for example,from inorganic or organic acids. For example, such conventional saltsinclude, but are not limited to, those derived from inorganic acids suchas hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, nitric andthe like; and the salts prepared from organic acids such as acetic,propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric,ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic,benzoic, salicylic, sulfanilic, 2-acetoxybenzoic, fumaric,toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, isethionic,and the like. Certain acidic or basic compounds of the present inventionmay exist as zwitterions. All forms of the compounds, including freeacid, free base, and zwitterions, are contemplated to be within thescope of the present invention.

As used herein, “prodrug” is intended to include any covalently bondedcarriers that release the active parent drug or whose form is converted,for example, as according to formula I, formula II, or formula III orother formulas or compounds employed in the methods of the presentinvention such as dapsone, in vivo when such prodrug is administered toa patient. Since prodrugs are known to enhance numerous desirablequalities of pharmaceuticals (e.g., solubility, bioavailability,manufacturing, etc.) the compounds employed in the present methods may,if desired, be delivered in prodrug form. Thus, the present inventioncontemplates methods of delivering prodrugs.

“Patient” refers to an animal, including a mammal, preferably a human.

Accordingly, the present invention is directed, in part, topharmaceutical compositions, comprising:

-   -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I:    -   or pharmaceutically-acceptable salt or prodrug thereof;    -   wherein:    -   A, B, C, and D are, independently, H, lower alkyl, cyano, OR⁵,        —C(═O)OR⁵, SR⁶, halo, SO₂R⁶, NR⁶R⁷, —SO₂NR⁶R⁷;    -   R¹ and R² are, independently, NH₂, NHC(═O)R³, or —N═NR⁴;    -   R³ is H, lower alkyl, -alkyl-OR⁵, -alkyl-C(═O)OR⁵, or        -alkyl-C(═O)NHR⁵;    -   R⁴ is    -   R⁵ is hydrogen, lower alkyl, substituted lower alkyl, lower        alkenyl, substituted lower alkenyl, lower alkynyl, substituted        lower alkynyl, aryl, haloaryl, substituted aryl, acyl, or        heterocyclyl;    -   R⁶ is independently hydrogen, alkyl, substituted lower alkyl,        lower alkenyl, substituted lower alkenyl, lower alkynyl,        substituted lower alkynyl, alkyl substituted aryl, or acyl; and    -   R⁷ is independently hydrogen, alkyl, substituted lower alkyl,        lower alkenyl, lower alkynyl, substituted lower alkenyl,        substituted lower alkynyl, alkyl substituted aryl, acyl, —SO₂R⁵,        or SO₂NR⁵R⁶.

Hydroxychloroquine, a substituted quinoline, and dapsone, a substituteddiphenyl sulfones have been used individually at high levels to preventand/or treat neurological disorders, including Alzheimer's dementia.However, it has been unexpectedly discovered that, when combined, asubstituted quinoline and a substituted diphenyl work synergistically toprevent and treat loss of neurons and hence are useful in the preventionand treatment of neurological disorders, including, inter alia,Alzheimer's dementia, HIV-1 associated dementia, and Creutzfeld-Jakobdisease, at lower levels.

The substituted quinoline and the substituted diphenyl sulfones of thepresent invention may be prepared in a number of ways well known tothose skilled in the art. The compounds can be synthesized, for example,by the methods described in the references listed below or variationsthereon as appreciated by the skilled artisan. All processes disclosedin association with the present invention are contemplated to bepracticed on any scale, including milligram, gram, multigram, kilogram,multikilogram or commercial industrial scale.

The substituted quinolines useful in the invention may be prepared bysynthetic techniques that are well known in the art. See, for example,Surrey, Hammer, J. Amer. Chem. Soc., 72, 1814, (1950) and U.S. Pat. No.2,546,658, the disclosures of which are herein incorporated byreference. Most of the substituted quinolines arecommercially-available.

The substituted diphenyl sulfone compounds of formula I useful in theinvention may be prepared by synthetic techniques that are well known inthe art. See, for example, U.S. Pat. No. 3,689,671; U.S. Pat. No.3,702,362; U.S. Pat. No. 3,715,375; U.S. Pat. No. 3,775,403; U.S. Pat.No. 3,775,444; U.S. Pat. No. 3,786,050, and U.S. Pat. No. 4,338,334; H.Heyman and L. F. Fieser, Journal of the American Chemical Society, 87,1979, (1945), the disclosures of which are herein incorporated byreference. Most of the substituted diphenyl sulfones arecommercially-available. For example, dapsone(4,4′-diaminodiphenylsulfone) is available from Jacobus PharmaceuticalsCompany, Inc.

In certain preferred embodiments, suitable substituted quinolinesinclude 4-aminoquinoline, 8-aminoquinoline, and hydroxymethylquinoline,or pharmaceutically acceptable salt or enantiomer or prodrug thereof.More preferred substituted quinolines include hydroxychloroquine,chloroquine, amodiaquine, amopyroquine, cycloquine, oxychloroquine,sontoquine, amodiaquine, primaquine, mefloquine, quinacrine, quinine,thalidomide, sulfasalazine, and sulfapyridine, or pharmaceuticallyacceptable salt or enantiomer or prodrug thereof. Even more preferredsubstituted quinolines include hydroxychloroquine or chloroquine, orpharmaceutically acceptable salt or enantiomer or prodrug thereof. Aparticularly preferred substituted quinoline is hydroxychloroquine orpharmaceutically acceptable salt or enantiomer or prodrug thereof.

In certain preferred embodiments, the pharmaceutical compositioncomprises the compound of formula I,

-   -   wherein A, B, C, and D are each H.

In certain preferred embodiments, the pharmaceutical compositioncomprises the compound of formula I,

-   -   wherein R¹ and R² are, independently, NH₂ or NHC(═O)R³,        preferably where R³ is methyl.        In even more preferred embodiments, R¹ and R² are each NH₂.

In certain preferred embodiments, R⁴ is

In certain preferred embodiments, the pharmaceutical compositioncomprises a compound of formula II:

-   -   or pharmaceutically-acceptable salt thereof.

In certain preferred embodiments, the pharmaceutical compositioncomprises a compound of formula III;

or pharmaceutically-acceptable salt thereof.

In certain preferred embodiments, the pharmaceutical compositioncomprises a compound of the formula:

-   -   or pharmaceutically-acceptable salt thereof.        This compound is also known as dapsone.

In certain preferred embodiments, the pharmaceutical compositioncomprises a compound of one of the following formulae, each of which isknown prodrug of dapsone, described above:

-   -   or pharmaceutical salt thereof.

It is believed the chemical formulas and names used herein correctly andaccurately reflect the underlying chemical compounds. However, thenature and value of the present invention does not depend upon thetheoretical correctness of these formulae, in whole or in part. Thus itis understood that the formulas used herein, as well as the chemicalnames attributed to the correspondingly indicated compounds, are notintended to limit the invention in any way, including restricting it toany specific tautomeric form or to any specific optical or geometricisomer.

When any variable occurs more than one time in any constituent or in anyformula, its definition in each occurrence is independent of itsdefinition at every other occurrence. Combinations of substituentsand/or variables are permissible only if such combinations result instable compounds. It is further understood that, while certainsubstituents are minimally required, the moiety may be furthersubstituted with the same substituent(s), another substituent(s) fromthe group of required substituents, or other substituent(s) not from thegroup of required substituents.

All forms of the compounds useful in the pharmaceutical compositions ofthe invention, including free acid, free base, and zwitterions,isomorphic crystalline forms, all chiral and racemic forms, hydrates,solvates, and acid salt hydrates, are contemplated to be within thescope of the present invention.

Compounds of the pharmaceutical compositions of the invention maycontain one or more asymmetrically substituted carbon atoms, and may beisolated in optically active or racemic forms. Thus, all chiral,diastereomeric, racemic forms and all geometric isomeric forms of astructure are intended, unless the specific stereochemistry or isomericform is specifically indicated. It is well known in the art how toprepare and isolate such optically active forms. For example, mixturesof stereoisomers may be separated by standard techniques including, butnot limited to, resolution of racemic forms, normal, reverse-phase, andchiral chromatography, preferential salt formation, recrystallization,and the like, or by chiral synthesis either from chiral startingmaterials or by deliberate synthesis of target chiral centers.

The compounds of the present invention may be made in the form of themonohydrohalic acid addition salts and/or the solvated compound, forexample the hydrochloride hydrate or the hydrobromide. Other salts maybe made however by simple reaction of a base with acid and may bedesirable in order to modify the properties of the product, such as itstoxicity, taste, physical form, or rate of release into the body. Forexample, the compounds may be made in the form of the sulfate,bisulfate, phosphate, nitrate, acetate, maleate, phthalate, succinate,phosphate, nitrobenzoate, stearate, mandelate, N-acetyl-glycinate,pamoate, sulfonate, di-sulfonate, cyclohexyl sulfamate, citrate,tartrate, propionate, glycolate, lactate, malate, ascorbate,hydroxymaleate, phenylacetate, glutamate, benzoate, salicylate,sulfanilate, 2-acetoxybenzoate, fumarate, toluenesulfonate,methanesulfonate, ethane disulfonate, isethionate, mesylate orgluconate, and the like.

The compounds (either the substituted quinolines or the substituteddiphenyl sulfones) of the pharmaceutical compositions of the inventionmay exist in prodrug form. Prodrugs include, for example, compoundsdescribed herein in which a hydroxy, amino, or carboxy group is bondedto any group that, when the prodrug is administered to a mammaliansubject, cleaves to form a free hydroxyl, free amino, or carboxylicacid, respectively. Examples include, but are not limited to, acetate,formate and benzoate derivatives of alcohol and amine functional groups;and alkyl, carbocyclic, aryl, and alkylaryl esters such as methyl,ethyl, propyl, iso-propyl, butyl, isobutyl, sec-butyl, tert-butyl,cyclopropyl, phenyl, benzyl, and phenethyl esters, and the like.

In some embodiments, the pharmaceutical compositions of the inventionfurther comprise a pharmaceutically acceptable carrier or diluent. Suchcompositions are prepared in accordance with acceptable pharmaceuticalprocedures, such as described in Remington's Pharmaceutical Sciences,17th edition, ed. Alfonoso R. Gennaro, Mack Publishing Company, Easton,Pa. (1985). Pharmaceutically acceptable carriers and/or diluents arethose that are compatible with the other ingredients in the formulationand biologically acceptable.

The compounds of this invention may be administered orally orparenterally, neat or in combination with conventional pharmaceuticalcarriers. Applicable solid carriers can include one or more substancesthat may also act as flavoring agents, lubricants, solubilizers,suspending agents, fillers, glidants, compression aids, binders ortablet-disintegrating agents or an encapsulating material. In powders,the carrier is a finely divided solid that is in admixture with thefinely divided active ingredient. In tablets, the active ingredient ismixed with a carrier having the necessary compression properties insuitable proportions and compacted in the shape and size desired. Thepowders and tablets preferably contain up to 99% of the activeingredient. Suitable solid carriers include, for example, calciumphosphate, magnesium stearate, talc, sugars, lactose, dextrin, starch,gelatin, cellulose, methyl cellulose, sodium carboxymethyl cellulose,polyvinylpyrrolidine, low melting waxes and ion exchange resins.

Oral formulations are preferred. Formulations for oral or injected useare based on sufficient solubility as to allow the therapeutic agent toenter solution in the stomach or in an injectable medium. Suitable drugformulations include, but are not limited to, tablets, pills, capsules,sachets, granules, powders, chewing gums, suspensions, emulsions,suppositories, and solutions. Particularly preferred for oral use aretablets and capsules of all varieties and microbe-free solutions forinjection or infusion. Where appropriate and necessary the formulationsmay include diluents, binding agents, dispersing agents, surface-activeagents, lubricating agents, coating materials, flavoring agents,coloring agents, controlled release formulations, sweeteners or anyother pharmaceutically acceptable additives, for example, gelatin,sodium starch glycolate, lactose, starch, talc, magnesium stearate,microcrystalline cellulose, Povidone, hydrogenated or unsaturated oils,polyglycols, syrups or other aqueous solutions. Where the formulationsare tablets or capsules and the like the formulations may be presentedas premeasured unit doses or in multidose containers from which theappropriate unit dose may be withdrawn.

Liquid carriers may be used in preparing solutions, suspensions,emulsions, syrups, and elixirs. The active ingredient of this inventioncan be dissolved or suspended in a pharmaceutically acceptable liquidcarrier such as water, an organic solvent, a mixture of both orpharmaceutically acceptable oils or fat. The liquid carrier can containother suitable pharmaceutical additives such as solubilizers,emulsifiers, buffers, preservatives, sweeteners, flavoring agents,suspending agents, thickening agents, colors, viscosity regulators,stabilizers, or osmo-regulators. Suitable examples of liquid carriersfor oral and parenteral administration include water (particularlycontaining additives as above, e.g. cellulose derivatives, preferablysodium carboxymethyl cellulose solution), alcohols (including monohydricalcohols and polyhydric alcohols e.g. glycols) and their derivatives,and oils (e.g. fractionated coconut oil and arachis oil). For parenteraladministration the carrier can also be an oily ester such as ethyloleate and isopropyl myristate. Sterile liquid carriers are used insterile liquid form compositions for parenteral administration.

Liquid pharmaceutical compositions, which are sterile solutions orsuspensions, can be administered by, for example, intramuscular,intraperitoneal or subcutaneous injection. Sterile solutions can also beadministered intravenously. Oral administration may be either liquid orsolid composition form.

The injectable form may be an aqueous or nonaqueous solution, suspensionor emulsion in a pharmaceutically acceptable liquid, e.g. sterilepyrogen-free water or parenterally acceptable oils or mixture of liquidswhich may contain bacteriostatic agents, antioxidants or otherpreservatives and stabilizers, buffers (preferably but not limited to aphysiological pH range of 6.5-7.7, solutes to render the solutionisotonic with the blood, thickening agents, suspending agents or otherpharmaceutically acceptable additives. Such forms will be presented inunit dose form such as ampules or disposable injection devices or inmulti-dose forms such as a bottle from which the appropriate dose may bewithdrawn, or as a solid form or concentrate that can be used to quicklyprepare an injectable formulation. All formulations for injection arepreferable as sterile and pyrogen free. Suppositories containing thecompound will also contain suitable carriers, e.g. cocoa butter,polyglycols or other state-of-the-art carriers.

Preferably the pharmaceutical composition is in single unit dosage form,e.g. as tablets, capsules, powders, solutions, suspensions, emulsions,granules, or suppositories. In such form, the composition is sub-dividedin unit dose containing appropriate quantities of the active ingredient;the unit dosage forms can be packaged compositions, for example packetedpowders, vials, ampoules, prefilled syringes or sachets containingliquids. The unit dosage form can be, for example, a capsule or tabletitself, or it can be the appropriate number of any such compositions inpackage form.

When the combination products are not formulated together in a singledosage form, the substituted quinoline and the substituted diphenylsulfone may be administered at the same time or simultaneously (that is,together), or in any order. When not administered at the same time orsimultaneously, that is, when administered sequentially, preferably theadministration of a substituted quinoline and the substituted diphenylsulfone occurs less than about one hour apart, more preferably less thanabout 30 minutes apart, even more preferably less than about 15 minutesapart, and still more preferably less than about 5 minutes apart.

In addition to standard pharmaceutical additives there may be includedwithin formulations of the compound other therapeutic agents.

The dosage of the composition of the present invention that will be mostsuitable for prophylaxis or treatment will vary with the form ofadministration, the particular compounds chosen and the physiologicalcharacteristics of the particular patient under treatment. Generally,small dosages may be used initially and, if necessary, increased bysmall increments until the desired effect under the circumstances isreached. Generally speaking, oral administration may require higherdosages.

Preferably, administration of the combination products of the inventionis oral, although other routes of administration, as described above,are contemplated to be within the scope of the present invention.Although it is preferable that the substituted quinoline and thesubstituted diphenyl sulfone are all administered in the same fashion(that is, for example, both orally), if desired, they may each beadministered in different fashions (that is, for example, one componentof the combination product may be administered orally, and anothercomponent may be administered intravenously). The dosage of thecombination products of the invention may vary depending upon variousfactors such as the pharmacodynamic characteristics of the particularagent and its mode and route of administration, the age, health andweight of the recipient, the nature and extent of the symptoms, the kindof concurrent treatment, the frequency of treatment, and the effectdesired.

Although the proper dosage of the pharmaceutical composition of thisinvention will be readily ascertainable by one skilled in the art, oncearmed with the present disclosure, by way of general guidance, typicallya daily dosage may range from about 0.01 to about 100 milligrams of thesubstituted quinoline (and all combinations and subcombinations ofranges therein) and about 0.001 to about 100 milligrams of thesubstituted diphenyl sulfone (and all combinations and subcombinationsof ranges therein) per kilogram of patient body weight. Preferably, thea daily dosage may be about 0.1 to about 10 milligrams of thesubstituted quinoline and about 0.1 to about 10 milligrams of thesubstituted diphenyl sulfone per kilogram of patient body weight. Evenmore preferably, the daily dosage may be about 1.0 to about 10.0milligrams of the substituted quinoline and about 1 to about 4.0milligrams of the substituted diphenyl sulfone per kilogram of patientbody weight. With regard to a typical dosage form of this type ofcombination product, such as a tablet, the substituted quinolinegenerally may be present in an amount of about 100 to about 300milligrams and the substituted diphenyl sulfone in an amount of about 25to about 100 milligrams. The preferred dosage form of the combinationproduct contains, preferably in tablet form, 50 mg of dapsone and 200 mgof hydroxychloroquine, wherein the combination product is administeredto the patient two times a day (bid). Alternatively, the combinationproduct may be administered once a day (os) or three times a day (tid).

Particularly when provided as a single dosage form, the potential existsfor a chemical interaction between the combined active ingredients,i.e., the substituted quinoline and the substituted diphenyl sulfone.For this reason, the preferred dosage forms of the combination productsof this invention are formulated such that although the activeingredients are combined in a single dosage form, the physical contactbetween the active ingredients is minimized (that is, reduced).

In order to minimize contact, one embodiment of this invention where theproduct is orally administered provides for a combination productwherein one active ingredient is enteric coated. By enteric coating oneor more of the active ingredients, it is possible not only to minimizethe contact between the combined active ingredients, but also, it ispossible to control the release of one of these components in thegastrointestinal tract such that one of these components is not releasedin the stomach but rather is released in the intestines. Anotherembodiment of this invention where oral administration is desiredprovides for a combination product wherein one of the active ingredientsis coated with a sustained-release material that effects asustained-release throughout the gastrointestinal tract and also servesto minimize physical contact between the combined active ingredients.Furthermore, the sustained-released component can be additionallyenteric coated such that the release of this component occurs only inthe intestine. Still another approach would involve the formulation of acombination product in which the one component is coated with asustained and/or enteric release polymer, and the other component isalso coated with a polymer such as a low-viscosity grade ofhydroxypropyl methylcellulose (HPMC) or other appropriate materials asknown in the art, in order to further separate the active components.The polymer coating serves to form an additional barrier to interactionwith the other component.

Dosage forms of the combination products of the present inventionwherein one active ingredient is enteric coated can be in the form oftablets such that the enteric coated component and the other activeingredient are blended together and then compressed into a tablet orsuch that the enteric coated component is compressed into one tabletlayer and the other active ingredient is compressed into an additionallayer. Optionally, in order to further separate the two layers, one ormore placebo layers may be present such that the placebo layer isbetween the layers of active ingredients. In addition, dosage forms ofthe present invention can be in the form of capsules wherein one activeingredient is compressed into a tablet or in the form of a plurality ofmicrotablets, particles, granules or non-pareils, which are then entericcoated. These enteric-coated microtablets, particles, granules ornon-pareils are then placed into a capsule or compressed into a capsulealong with a granulation of the other active ingredient.

These as well as other ways of minimizing contact between the componentsof combination products of the present invention, whether administeredin a single dosage form or administered in separate forms but at thesame time by the same manner, will be readily apparent to those skilledin the art, once armed with the present disclosure.

In certain embodiments, the invention is directed to methods of treatinga disorder associated with neuron loss, comprising the step of:

-   -   administering to a patient in need thereof an effective amount        of the composition, comprising:    -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I or        pharmaceutically-acceptable salt or prodrug thereof, as defined        above.        The disorders associated with neuron loss include, inter alia,        Alzheimer's dementia. HIV-1 associated dementia, spongiform        encephalopathy, Creutzfeld-Jakob disease, stroke, trauma,        multiple sclerosis, Parkinson's disease, HIV infection of the        central nervous system, hereditary hemorrhage with        amyloidosis-Dutch type, cerebral amyloid angiopathy, or Down's        syndrome. The method of the invention is particularly useful for        the prevention and treatment of neuron loss associated with        Alzheimer's dementia, HIV-1 associated dementia, and        Creutzfeld-Jakob disease. In certain preferred embodiments, the        composition is administered during the early progression of the        neurodegenerative disorder.

In certain other embodiments, the invention is directed to methods oftreating a neurodegenerative disorder, comprising the step of:

-   -   administering to a patient in need thereof an effective amount        of the composition, comprising:    -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I or        pharmaceutically-acceptable salt or prodrug thereof, as defined        above.        The disorders associated with neuron loss include, inter alia,        Alzheimer's dementia, HIV-1 associated dementia, spongiform        encephalopathy, Creutzfeld-Jakob disease, stroke, trauma,        multiple sclerosis, Parkinson's disease, HIV infection of the        central nervous system, hereditary hemorrhage with        amyloidosis-Dutch type, cerebral amyloid angiopathy, or Down's        syndrome. The method of the invention is particularly useful for        the prevention and treatment of Alzheimer's dementia, HIV-1        associated dementia, and Creutzfeld-Jakob disease. In certain        preferred embodiments, the composition is administered during        the early progression of said neurodegenerative disorder.

In further aspect, the invention is directed to methods of treating apatient at risk of cognitive loss, comprising the step of:

-   -   administering to said patient an effective amount of the        composition, comprising:    -   at least one substituted quinoline or        pharmaceutically-acceptable salt or enantiomer or prodrug        thereof; and    -   at least one compound of formula I or        pharmaceutically-acceptable salt or prodrug thereof, as defined        above.        Such patients may be afflicted with mild cognitive impairment,        mild cognitive motor dysfunction, HIV-associated dementia,        neuro-AIDS, prion disease, acute stroke or acute trauma. In        certain preferred embodiments, the composition is administered        during the early progression of said cognitive loss.

The present invention is further defined in the following Examples, inwhich all parts and percentages are by weight, unless otherwise stated.It should be understood that these examples, while indicating preferredembodiments of the invention, are given by way of illustration only.From the above discussion and these examples, one skilled in the art canascertain the essential characteristics of this invention, and withoutdeparting from the spirit and scope thereof, can make various changesand modifications of the invention to adapt it to various usages andconditions.

EXAMPLES

The compositions of the invention and comparative compounds andcompositions were evaluated in accordance with the test methodsdescribed in U.S. Pat. No. 6,043,283; U.S. Pat. No. 6,071,493; U.S. Pat.No. 6,451,544; U.S. Pat. No. 6,451,742; and U.S. Pat. No. 6,475,745, thedisclosures of which are incorporated herein by reference. In general,the drug assays involved the addition of known concentrations of a testagent over a range of concentrations. After 72 hours, the experiment wasstopped and the neurons were identified by immuno-staining. The data wasexpressed as % neuronal survival at I-(neuronal number is testsample/neuronal number in untreated control sample))×100%. Dose responsecurves were then used to estimate the effective for dose (50%) of theneuroprotective agent (defined as the ED₅₀).

Abbreviations:

-   DAP dapsone-   HCQ hydroxychloroquine-   AD Alzheimer's disease

FIG. 1 is a plot of % neuron loss for several test agents (homozygouscontrol, methylcellulose, hydroxychloroquine at a level of 6.5 mg/kg,thalidomide at a level of 2 mg/kg, dapsone at a level of 2 mg/kg, andthe combination of hydroxychloroquine and dapsone at 10% of theirrespective individual doses, i.e., 0.65 mg/kg hydroxychloroquine+0.2mg/kg dapsone. It is observed in FIG. 1 that in vitro hydroxychloroquine(a substituted quinoline) alone at high levels (6.5 mg/kg), dapsone (asubstituted diphenyl sulfone) alone at high levels (2 mg/kg), and thecombination of hydroxychloroquine (a substituted quinoline) and dapsone(a substituted diphenyl sulfone) at 10% of their respective individualdoses, i.e., 0.65 mg/kg hydroxychloroquine+0.2 mg/kg dapsone produced asuppression of the in vitro killing effect.

FIG. 2 is a plot of % neuron loss as a function of drug concentrationfor several test agents (10 nM hydroxychloroquine, the combination of0.1 nM hydroxychloroquine+dapsone), the combination of 0.3 nMhydroxychloroquine+dapsone), the combination of 1.0 nMhydroxychloroquine+dapsone).

An isobologram is useful for determine where the effects of two agentsare additive, potentiating (positively synergistic), or antagonistic(negatively synergistic). Points falling on the curved line representinga simple additive effect of the two agents, points falling in the areato the left of the curved line representing a potentiating (positivelysynergistic) effect of the two agents, and points falling in the area tothe right of the curved line representing an antagonistic (negativelysynergistic) effect of the two agents.

It is observed in the isobologram of FIG. 3 that, when thehydroxychloroquine (a substituted quinoline) and dapsone (a substituteddiphenyl sulfone) were combined, the combination was effective at lowerlevels at all tested concentrations and exhibited a potentiating(positively synergistic) effect.

It has also been demonstrated in vivo that combinations ofhydroxychloroquine (a substituted quinoline) and dapsone (a substituteddiphenyl sulfone) show potentiation and achieved a reduction inneurotoxin levels in the spinal fluid of patients afflicted withAlzheimer's dementia in six-month clinical trials (as shown in FIG. 4)and of patients afflicted with HIV in a six-week clinical trial (asshown in FIG. 5). In addition, these patients were able to demonstratean improvement in standard test with respect to cognitive function.

When ranges are used herein for physical properties, such as molecularweight, or chemical properties, such as chemical formulae, allcombinations and subcombinations of ranges specific embodiments thereinare intended to be included.

The disclosures of each patent, patent application, and publicationcited or described in this document are hereby incorporated herein byreference, in their entirety.

Those skilled in the art will appreciate that numerous changes andmodifications can be made to the preferred embodiments of the inventionand that such changes and modifications can be made without departingfrom the spirit of the invention. It is, therefore, intended that theappended claims cover all such equivalent variations as fall within thetrue spirit and scope of the invention.

1. A pharmaceutical composition, comprising: at least one substitutedquinoline or pharmaceutically-acceptable salt or enantiomer or prodrugthereof; and at least one compound of formula I:

or pharmaceutically-acceptable salt or prodrug thereof; wherein: A, B,C, and D are, independently, H, lower alkyl, cyano, OR⁵, —C(═O)OR⁵, SR⁶,halo, SO₂R⁶, NR⁶R⁷, —SO₂NR⁶R⁷; R¹ and R² are, independently, NH₂,NHC(═O)R³, or —N═NR⁴; R³ is H, lower alkyl, -alkyl-OR⁵, -alkyl-C(═O)OR⁵,or -alkyl-C(═O)NHR⁵; R⁴ is

R⁵ is hydrogen, lower alkyl, substituted lower alkyl, lower alkenyl,substituted lower alkenyl, lower alkynyl, substituted lower alkynyl,aryl, haloaryl, substituted aryl, acyl, or heterocyclyl; R⁶ isindependently hydrogen, alkyl, substituted lower alkyl, lower alkenyl,substituted lower alkenyl, lower alkynyl, substituted lower alkynyl,alkyl substituted aryl, or acyl; and R⁷ is independently hydrogen,alkyl, substituted lower alkyl, lower alkenyl, lower alkynyl,substituted lower alkenyl, substituted lower alkynyl, alkyl substitutedaryl, acyl, —SO₂R⁵, or SO₂NR⁵R⁶.
 2. The pharmaceutical compositionaccording to claim 1, further comprising a pharmaceutically acceptablecarrier or diluent.
 3. The pharmaceutical composition according to claim1, wherein said substituted quinoline is a 4-aminoquinoline,8-aminoquinoline, or hydroxymethylquinoline, or pharmaceuticallyacceptable salt or enantiomer or prodrug thereof.
 4. The pharmaceuticalcomposition according to claim 1, wherein said substituted quinoline ishydroxychloroquine, chloroquine, amodiaquine, amopyroquine, cycloquine,oxychloroquine, sontoquine, amodiaquine, primaquine, mefloquine,quinacrine, quinine, thalidomide, sulfasalazine, or sulfapyridine, orpharmaceutically acceptable salt or enantiomer or prodrug thereof. 5.The pharmaceutical composition according to claim 3, wherein saidsubstituted quinoline is hydroxychloroquine or chloroquine, orpharmaceutically acceptable salt or enantiomer or prodrug thereof. 6.The pharmaceutical composition according to claim 3, wherein saidsubstituted quinoline is hydroxychloroquine or pharmaceuticallyacceptable salt or enantiomer or prodrug thereof.
 7. The pharmaceuticalcomposition according to claim 1, wherein A, B, C, and D are each H. 8.The pharmaceutical composition according to claim 1, wherein R¹ and R²are, independently, NH₂ or NHC(═O)R³.
 9. The pharmaceutical compositionaccording to claim 8, wherein R¹ and R² are each NH₂.
 10. Thepharmaceutical composition according to claim 8, wherein R³ is methyl.11. The pharmaceutical composition of claim 1, wherein said compound isa compound of formula II:

or pharmaceutically-acceptable salt thereof.
 12. The pharmaceuticalcomposition of claim 11, wherein said compound is a compound of formulaIII:

or pharmaceutically-acceptable salt thereof.
 13. The pharmaceuticalcomposition according to claim 12, wherein said compound is:

or pharmaceutically-acceptable salt thereof.
 14. The pharmaceuticalcomposition according to claim 1, wherein said prodrug is sulfoxonesodium (diasone), sulfetrone, or promin or pharmaceutically-acceptablesalt thereof.
 15. The pharmaceutical composition according to claim 1,wherein said substituted quinoline and said compound of formula I are ina single unit dosage form.
 16. A method of treating a disorderassociated with neuron loss, comprising the step of: administering to apatient in need thereof an effective amount of the composition accordingto claim
 1. 17. The method according to claim 16, wherein said disorderis Alzheimer's dementia, HIV-1 associated dementia, spongi formencephalopathy, Creutzfeld-Jakob disease, stroke, trauma, multiplesclerosis, Parkinson's disease, HIV infection of the central nervoussystem, hereditary hemorrhage with amyloidosis-Dutch type, cerebralamyloid angiopathy, or Down's syndrome.
 18. The method according toclaim 17, wherein said disorder is Alzheimer's dementia, HIV-1associated dementia, or Creutzfeld-Jakob disease.
 19. The methodaccording to claim 18, wherein said disorder is Alzheimer's dementia.20. The method according to claim 18, wherein said disorder is HIV-1associated dementia.
 21. The method according to claim 18, wherein saiddisorder is Creutzfeld-Jakob disease.
 22. The method according to claim16, wherein said composition is administered during the earlyprogression of said disorder.
 23. A method of treating aneurodegenerative disorder, comprising the step of: administering to apatient in need thereof an effective amount of the composition accordingto claim
 1. 24. The method according to claim 23, wherein saidneurodegenerative disorder is Alzheimer's dementia, HIV-1 associateddementia, spongiform encephalopathy, Creutzfeld-Jakob disease, stroke,trauma, multiple sclerosis, Parkinson's disease, HIV infection of thecentral nervous system, hereditary hemorrhage with amyloidosis-Dutchtype, cerebral amyloid angiopathy, or Down's syndrome.
 25. The methodaccording to claim 24, wherein said neurodegenerative disorder isAlzheimer's dementia, HIV-1 associated dementia, or Creutzfeld-Jakobdisease.
 26. The method according to claim 25, wherein saidneurodegenerative disorder is Alzheimer's dementia.
 27. The methodaccording to claim 25, wherein said neurodegenerative disorder is HIV-1associated dementia.
 28. The method according to claim 25, wherein saidneurodegenerative disorder is Creutzfeld-Jakob disease.
 29. The methodaccording to claim 23, wherein said composition is administered duringthe early progression of said neurodegenerative disorder.
 30. A methodof treating a patient at risk of cognitive loss, comprising the step of:administering to said patient an effective amount of the compositionaccording to claim
 1. 31. The method according to claim 30, wherein saidpatient is afflicted with mild cognitive impairment, mild cognitivemotor dysfunction, HIV-associated dementia, neuro-AIDS, prion disease,acute stroke or acute trauma.
 32. The method according to claim 30,wherein said composition is administered during the early progression ofsaid cognitive loss.